Pills for old men or young women?November 12th, 2009 by Roy Berman |
 |
The US healthcare reform bill that recently passed the House only did so after a controversial amendment was inserted banning any insurance plan which pays for abortion from accepting any federal subsidies, a clause that will probably eliminate abortion from most or all health plans if it goes into law. One reader at TPM had the following thought experiment:
What would happen if a few female members of the House put in (or merely proposed) an amendment to the health care bill which stated that men would be barred BY LAW from purchasing health insurance which covered Viagra, all hair-growth medications or procedures or transplants, etc.?
This thought experiment reminded me of the well known case of the birth control in Japan. Actually, I say well known, but when I checked to confirm the dates, the details were rather more complex than the simplistic version of the story that I had thought I knew, in which the pill was simply never legalized in Japan until a decade ago.
The first birth control pill was approved for that use by the United States FDA in 1960, but was rarely used in Japan until recently. The pill was not approved at all in Japan until 1972, but this was the high-dose formulation that was already being replaced in other countries with a low-dose version of the drug due to safety reasons. Because the safer, low-dose pill was never approved in Japan, oral contraceptives remained little used. Even after the original high-dose formulation was removed from the market in the US in 1988, the low-dose pill remained off the market in Japan.
This changed in 1999, after Viagra was fast-tracked for approval. Viagra first went on sale in the US in March 1998, and only a few months later was already being studied for approval in Japan, where it went on sale in March 1999 – only one year after the US. Feminists complained about a double standard that allowed a drug whose primary purpose is allowing recreational sex for old men to be approved almost immediately, while the safe low-dose birth control pill was still not approved after four decades. At the time, Yoshiaki Kumamoto, president of the Japan Foundation of Sexual Health Medicine, was quoted as saying that viagra was approved so quickly because old men in parliament “want to have that drug.”
The modern pill was finally approved in September of 1999, although women taking it are required to have pelvic exams four times a year, as opposed to once or twice in most countries, and there is still a widely held association with the dangerous side effects of the old formulation. According to a late 2006 study, only 1.8% of Japanese women were using the pill for their birth control needs. This compares with, according to UN figures for the year 2005, 7.5% of women worldwide, and 15.9% of women in developed countries.
November 12th, 2009 at 9:28 am
This has always seemed more insidious to me than simple sexism and placing priorities on the interests of men over women. Frankly, I have always believed that the efforts to dissuade women from taking the pill are based in a desire to place control for reproductive choices more squarely with men. If a woman takes the pill, she can decide if she gets pregnant or not. With condoms, the man has the control. At the very least, he knows if protection is in place or not.
I think that the dangers of the pill continue to be exaggerated in large part as a means to keep reproductive choices in the hands of men. They had to legalize it after Viagra was fast-tracked, but they use fear and inconvenience to make women decide not to use it.
November 12th, 2009 at 9:57 am
Very easy availability of abortion throughout the postwar period, however. In addition, strong local womens organization participation in door to door contraception drives through the 1950s and 1960s – with various forms of contraception (not just condoms) being considered the woman’s responsibility.
November 12th, 2009 at 10:21 am
I know (albeit not very well) one man who allegedly re-sorted his wife’s birth control pills so she would have a second child.
Anyway, as a man, I strongly believe that access to the pill should be deregulated. The reproductive control argument is important. Just as important is the fact that condoms are annoying as hell. They break sometimes, they don’t stay on right sometimes, they aren’t always convenient to where you’re having sex, and it’s hard to keep up a decent sexual experience when you have to fool around with them near the peak of your liaison. I suspect there are a lot of people who follow the risky “withdrawal method” (which is apparently the #2 contraception strategy in Japan) because they hate condoms and don’t have any decent alternatives available.
November 12th, 2009 at 10:39 am
There’s always been the economic conspiracy that condom makers and abortionists did not want the Pill legalized. This seems plausible, although there would need to be some kind of evidence of their lobbying the LDP. But I don’t think the LDP was inclined to legalize the pill to start with…
November 12th, 2009 at 11:07 am
Now that that LDP lot are out, I’m all for a complete rethinking.
November 12th, 2009 at 12:06 pm
The pill issue has caused a lot of problems with my girlfriend—it took weeks of trying to convince her that it was safe and for her benefit to use it, and she’s still not keen on paying for it herself (so I’m paying, for now).
The lack of proper, modern sexual education in this country is appalling—even the US knows how to incorporate the pill into a healthy lifestyle, and that’s saying something.
November 12th, 2009 at 8:46 pm
Man, rabuho, you need to rethink how you tell that story—it makes you sound like a dude who harangued his girlfriend for weeks until she agreed to take artificial hormones against her will, and is now complaining because she won’t pay for the privilege too.
I had heard that abortion was legal throughout the postwar period mostly as a reaction to the Ishikawa Miyuki affair. This explains the apparent inconsistency w/r/t the (convenient) pill—by the time it was available, everyone had forgotten Ishikawa, and there wasn’t the same sense of urgency to ensure that all babies were wanted.
November 12th, 2009 at 9:12 pm
“I had heard that abortion was legal throughout the postwar period mostly”
Strong lobbying from womens groups in the 1950s was a big factor. The same lobbying movement that made prostitution technically illegal. I think that they just used Ishikawa to support a movement that already had considerable support.
“The lack of proper, modern sexual education in this country is appalling”
You should check out the AIDS and teen pregnancy rates, however.
November 12th, 2009 at 10:38 pm
You should check out the AIDS and teen pregnancy rates, however.
C’mon, these are clearly correlations to sexual education rather than causation. Heterosexual sex is not the primary cause of AIDS in any developed nation. Japan can have bad sexual education AND low pregnancy rates.
November 12th, 2009 at 11:26 pm
Those numbers don’t provide evidence of good sex education in Japan and I agree that there is little connection. I bring it up because the US numbers do suggest lousy/backward sex education (go abstinence!) there too and that was the original point of comparison. There are no doubt some fantastic sex ed programs in the US, but I doubt there are any schools in Japan where you can get sent home for saying “condom” in class.
November 13th, 2009 at 12:54 am
rabuho, same experience here.
Japan doesn’t have a problem with sex education; it has a problem with misinformation being spread on purpose. I always believed the 医師会 conspiracy theory, they do get a lot of money from abortions.
Although I hear that most gynecologists are very supportive of the pill. All girls change their mind about the pill once they actually go to the hospital.
November 13th, 2009 at 1:19 am
M-Bone,
Something can be lousy without the implied relativity to the U.S. I taught for three years in public schools here, and would like to say that I know what sex ed is like in Japan, except that the teachers ended up balking on the curriculum, and stashed the teaching materials away in the storeroom before ever passing them out.
Now is that a crime? Maybe not, but it’s clear to me from talking to a significant sample of grown adults here (many from first and second tier universities, not that that says all that much) that there is a lack of understanding of (1) reproductive hormones; (2) contraceptive methods and their relative efficacies; (3) major STDs and how they are spread.
Roy,
I was surprised to see that women are required to have pelvic exams four times a year. So was my wife as well…
November 13th, 2009 at 1:42 am
“Something can be lousy without the implied relativity to the U.S. ”
Not the way that rabuho wrote it. What he writes about the US is wrong and the comparison with Japan places it as, what, “pre-modern”?
November 13th, 2009 at 8:38 am
” Heterosexual sex is not the primary cause of AIDS in any developed nation. ”
What about Botswana and South Africa ?
November 13th, 2009 at 9:48 am
Here’s what I mean –
CDC July 17, 2009 Morbidity and Mortality Weekly Report – about 1/3 of American teens received no education about birth control.
November 13th, 2009 at 11:40 am
Man, rabuho, you need to rethink how you tell that story—it makes you sound like a dude who harangued his girlfriend for weeks until she agreed to take artificial hormones against her will, and is now complaining because she won’t pay for the privilege too.
Yeah, I can see how you might read it that way. But considering this was just after we had a scare involving a broken condom and feverish searching for a place that would sell emergency contraception without ripping us off, it was a necessary conversation.
Also, I think it’s only fair to split the costs of birth control 50/50, no? Hell, even 75/25 would be fine with me, since I make more than she does…
You should check out the AIDS and teen pregnancy rates, however.
Yes, they are likewise appalling. And regarding my comparison to the US: I’m American, so it comes naturally, for better or worse. I’m well aware that there are plenty of places in the US with backwards sex ed, and I’m sure the overall level of sex ed in Japanese schools is not bad. However, there is still quite a lot of misinformation and just plain falsehoods (especially regarding female birth control) that really should be fought with better education of doctors, patients, and society at large. The media should also play a larger role in disseminating factual information, seeing as how they’re trusted by so much of the Japanese public.
All right, no more ranting for today. Work beckons…
November 13th, 2009 at 11:54 am
As partially a product of the Japanese education system, I can attest to the excellence of sex education in Japan. At my first school ceremony. A nurse was called on stage to give a speech about sex, and about how there was no shame in being a virgin if you were unsure about having it. She then explained all the options out there in terms of contraceptives. Then she pulled a large elongated object out of her bag of tricks and showed us how to put a condom on.
This was a university nyugakushiki. It was also a room full of graduate students. I was 25 years old.
Soon after that some friends of mine blew that joint mid-ceremony and headed for a nomi-houdai place I knew about for some afternoon drinking. Unfortunately, it didn’t lead to the opportunity to practice what I had learned that night.
November 13th, 2009 at 11:55 am
oops, whats with that name.
November 13th, 2009 at 12:02 pm
Cheers on the follow up post rabuho.
November 13th, 2009 at 12:11 pm
A funny aside – did you guys hear about that incident a few years back where a Kanagawa PTA went ape shit when they found out that a sex ed class included showing students how to 69 with anatomically correct dolls? (This wasn’t a “perv” thing, it was put together by female teachers interested in the “gender free” line).
On a more serious note, I have seen some Japanese sex ed school resources and they looked fine to me. Especially good on presenting homosexuality as a natural feeling thing. Some schools have even started introducing them in the last year of Shogakko.
I really can’t remember doing any sex ed myself come to think of it. Like others of my nationality/generation, everything that I learned about sex, contraception, molestation, and AIDS came from Degrassi High.
November 13th, 2009 at 12:52 pm
Not sure what Degrassi High is (a TV prog, I guess), but yeah, I’m largely a product of the pre-sex ed years (unless you count dry lessons in Human Reproduction in Biology class, which were all about zygotes and mitochrondrial division, and nothing about condoms) and yet I have managed with just the information I gleaned from sneaked peeks at Penthouse (“Ooh! Girls like to have sex in high heels!”).
Certainly no sex ed at my university, either undergrad or post-grad.
November 13th, 2009 at 1:09 pm
“Certainly no sex ed at my university, either undergrad or post-grad.”
Is it kokuritsu? And are students also spared the implicitly mandatory health checks? I often wondered whether private universities did that type of thing. Or maybe my university was just strange.
November 13th, 2009 at 2:42 pm
In my year at Japanese high school there was no sex education. And, I might note, I was pretty appalled how the (granted, relatively few) girls I was with viewed protection casually. (But hey, I was in a redneck town, and in university, this was different). Joe, Adamu, and anyone else who did high school in Japan, did you experience anything different? (With the education, not so much the personal experience with girls.)
November 13th, 2009 at 3:51 pm
It was kokuritsu, but we did have the odd health check.
I did a year at a Japanese high school, quite sans sex education that I was aware of….
November 13th, 2009 at 11:26 pm
While we are on the topic, we DID have a day of sex ed during my year of Japanese high school. Just one day, though. It involved talking about how babies are made and all the nasty diseases you can get. And it was given by the scary phys ed teacher.
November 14th, 2009 at 2:47 am
“It involved talking about how babies are made and all the nasty diseases you can get. ”
Isn’t that what sex ed is like everywhere? Did they have embarrassingly outdated videos?
November 14th, 2009 at 3:27 am
Did they have live demonstrations? Perhaps a la The Meaning of Life?
November 16th, 2009 at 11:11 am
Not sure what Degrassi High is (a TV prog, I guess)
One of Canada’s cultural exports that has gone unseen by most of the rest of the English-speaking world. I recall seeing reruns on late-night cable TV in the US, but otherwise it’s unknown there.
November 16th, 2009 at 12:03 pm
I used to watch Degrassi on PBS once in a while, although I barely remember it. I don’t think I even knew it was set in Canada at the time because really, who could tell the difference?
I’ve never seen any evidence of sex ed in Japanese universities, but anecdotally the withdrawal method seems to be far more common among people who should know better.
November 16th, 2009 at 12:35 pm
“I don’t think I even knew it was set in Canada at the time because really, who could tell the difference?”
For Canadians, the Canadian-ness of it is overpowering (like Kids in the Hall). Of course, there is also this instant instinctual awareness that Half Baked was shot in TO.
Jade, for Degrassi, think Shortland Street for 15 year olds.
“but anecdotally the withdrawal method seems to be far more common among people who should know better.”
True, but if the statistics are correct, Japanese are pretty damn good at it.
I’m not sure that university is the place for sex ed, but given recent stats that suggest that nearly 1/3 of Japanese have their first sexual experience between 17 and 19, pamphlets or something wouldn’t be a bad idea.
November 16th, 2009 at 8:21 pm
At my university in the US there wasn’t exactly sex ed like in high school, but I think there were orientation seminars about protecting oneself from date-rape, but I can’t remember if there was also something about safe-sex when it was voluntary.
November 17th, 2009 at 1:44 am
“Jade, for Degrassi, think Shortland Street for 15 year olds.”
Slightly hampered by never having seen a single episode of SS, but I get the idea, thanks. Something I would be unlikely to find overly interesting.